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originating from a peripheral nerve, such a s cer ta in compressive neuropathies (ner ve entrapment), periphera l ner ve injuries a nd intercosta l neura lg ias. Occipital Nerve Stimulation Occipita l ner ve stimulation devices act directly on branches of the occipita l ner ve . T he g r e a t er o c cipit a l ner ve prov ides sen sat ion t o t he sca lp a nd tempora l reg ion. The lesser occipita l ner ve prov ides sensation to t he ea r. O c c i p i t a l n e r v e s t i m u l a t i o n i s a m i n i m a l l y i n v a s i v e t e c h n i q u e i n which the stimulator is placed nea r the cer vico-occipita l junction. Indications for occipita l ner ve stimulation include ch ron ic hea d a che (def i ned a s 15 or more hea d a che d ay s per mont h for more t h a n t h ree mont h s), occipit a l neu r a l g i a , c er v ic o gen ic he a d a c he , ch ron ic m ig ra i ne, cluster hea da che a nd hemicra nia continua . Motor Cortex Stimulation Motor cor tex sti mu lation dev ices a c t on t he pr i m a r y mot or cor t ex i n t he bra i n . Motor cor tex sti mu lation c a n b e u s e d t o t r e a t p o s t - s t r o k e pa i n , at y pica l fa cia l pa i n a nd ot her ch ron ic ref ractor y pa i n sy nd romes. In investigationa l applications, motor cortex stimulation has been used to treat A few of t he more com mon ly used neuromodulation techniques include spi na l cord sti mu lation, dorsa l root g a n g l i o n s t i m u l a t i o n , p e r i p h e r a l ner ve s t i mu l a t ion , o c cipit a l ner ve stimulation, motor cor tex stimulation, d e e p b r a i n s t i mu l a t i on a n d v a g a l ner ve stimulation. Spinal Cord Stimulation Spina l cord stimulation devices may be used for chronic refractor y back pain a nd pa in persisting a f ter back surger y. Spinal cord stimulation may also be used for diabetic neuropathy, chemotherapy- induced neuropathy, phantom limb pain following a mputation, pa in associated w it h p e r iph e r a l v a s c u l a r d i s e a s e , abdomina l pain, perinea l pain and other pa in syndromes. Dorsal Root Ganglion Stimulation Dorsal root ganglion stimulation devices act on the sensor y ner ves in the dorsa l root ganglia of the spina l column. Dorsa l root ga nglion stimulation may be used for complex reg iona l pa in sy ndrome, ex tremity pa in, groin neura lgia, pelvic pa in a nd other pa in syndromes. Peripheral Nerve Stimulation Periphera l ner ve stimulation devices act directly on periphera l ner ves a nd may be eff icacious in patients with pain other conditions including dysphag ia , aphasia, movement disorders and some psychiatric disorders. Deep Brain Stimulation D e e p b r a i n s t i mu l a t i on d e v i c e s a ct on speci f ic a rea s of t he bra i n to control abnorma l bra in activit y. Deep bra in stimu lation is most common ly used in non-pa in conditions such a s Pa rkinson's disease, essentia l tremor, epilepsy, obsessive-compulsive disorder a nd dystonia . Deep brain stimulation is rarely used for chronic pain; however, some studies eva luat ed t he t reat ment of ch ron ic pa in w ith deep bra in stimu lation for c on d i t i on s s u c h a s p h a n t om l i m b syndrome, brachia l plexus injuries a nd post-stroke pain. Common target areas in the bra in for treatment of chronic p a i n w i t h d e e p b r a i n s t i mu l a t i on include the periventricula r reg ion a nd pa r ts of the tha la mus. Vagal Nerve Stimulation Vaga l ner ve stimulation devices act d i rect ly on t he va g us ner ve a nd a re more commonly used to treat non-pa in conditions, such as seizures. Vagal nerve stimulation devices can a lso be applied to va rious chronic pa in syndromes, as well as refractor y depression. Conditions Treated CHRONIC PA IN CONDITIONS that neuromodulation can treat include but are not limited to: + Abdominal pain + Atypical facial pain + Chronic headache + Cluster headache + Complex regional pain syndrome + Failed back syndrome + Groin pain + Intercostal pain + Perineal pain + Peripheral nerve injuries or compression + Peripheral polyneuropathy, such as diabetic- or chemoradiation- induced neuropathies + Phantom limb pain + Postherpetic neuralgia + Post-stroke pain Other conditions that can be treated with neuromodulation include but are not limited to the following: • Depression • Dystonia • Essential tremor • Incontinence • Obsessive- compulsive disorder • Parkinson's syndrome • Seizures • Tourette's syndrome Most neuromodulation devices (as seen here) require implantation of a neurostimulator device with electrodes placed at the target site. In general, neurostimulation works by using electrical impulses to interrupt the pain signal to the brain. The patient's perception of pain is replaced with a more tolerable tingling sensation (paresthesia). 0 8❱❱❱❱❱ C O V E R F E A T U R E

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